2005-2017年广东省猩红热流行特征分析
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摘要
目的分析2005—2017年广东省猩红热的流行特征,为防控猩红热提供科学依据。方法应用描述性流行病学方法分析国家疾病监测信息报告管理系统中2005—2017年广东省猩红热病例时间、地区和人群分布特征;应用Joinpoint软件估计发病率平均年度变化百分比(AAPC),分析猩红热发病趋势;对2017年分离的66株A族β溶血性链球菌(GAS)进行emm基因分型和抗生素敏感性分析。结果 2005—2017年广东省共报告猩红热病例20 157例,年均发病率为1.46/10万,无死亡病例。发病呈夏、冬两季高发特点;报告发病率高的地区为珠江三角洲地区,病例数占全省的95.79%;病例主要集中在3～7岁,以托幼儿童、散居儿童和学生为主。广东省猩红热发病水平总体呈上升趋势,AAPC为26.4%(95%CI:16.9%～36.7%)。GAS菌株emm基因型别以emm12型为主(65.12%),emm1型次之(32.56%);菌株对红霉素、克林霉素、四环素耐药;对青霉素、头孢噻肟和左旋氧氟沙星均敏感。结论 2005—2017年广东省猩红热发病水平总体呈上升趋势,三间分布特征未见明显变化;当前GAS菌株流行基因型为emm12和emm1,且菌株对青霉素敏感。
Objective To analyze the epidemiologic characteristics of scarlet fever from 2005 to 2017, in Guangdong, and provide evidence for prevention and control of scarlet fever. Methods Descriptive epidemiologic analysis was conducted on the spatial, temporal and population distributions of scarlet fever cases reported through national infectious disease reporting and management system in Guangdong from 2005 to 2017. Joinpoint regression software was performed to obtain the average annual percentage changes(AAPC) of incident rates and analyze the incident trends. A total of 66 strains of betahaemolyticgroup A Streptococcus pyogens(GAS) isolated in 2017 were analyzed through emm typing and antibiotic susceptibility test. Results A total of 20 157 scarlet fever cases were reported in Guangdong from 2005 to 2017, with the annual incidence rates of 1.46/100 000. More cases were reported in summer and winter. High incidences were reported in Pearl River Delta region, with the proportion of 95.79% to the total cases of the province. Most cases were children aged 3 to 7 years. The proportion of children in kindergarten is the highest, followed by scattered children and students. The incidence of scarlet fever in Guangdong was on the rise, and the AAPC was 26.4%(95%CI: 16.9%–36.7%). The most prevalent emm type of pathogenic bacteria was emm12(65.12%), followed by emm1(32.56%). The strains were all resistant to erythromycin,clindamycin and tetracycline, and the bacteria were all sensitive to pencillin, cefotaxime and levofloxacin. Conclusion The incidence of scarlet fever in Guangdong was on the rise, but no obvious change were observed in the epidemiological patterns.The prevalent emm type of GAS was emm12 and emm1, and strains of GAS were sensitive to pencillin.
Objective To analyze the epidemiologic characteristics of scarlet fever from 2005 to 2017, in Guangdong, and provide evidence for prevention and control of scarlet fever. Methods Descriptive epidemiologic analysis was conducted on the spatial, temporal and population distributions of scarlet fever cases reported through national infectious disease reporting and management system in Guangdong from 2005 to 2017. Joinpoint regression software was performed to obtain the average annual percentage changes(AAPC) of incident rates and analyze the incident trends. A total of 66 strains of betahaemolyticgroup A Streptococcus pyogens(GAS) isolated in 2017 were analyzed through emm typing and antibiotic susceptibility test. Results A total of 20 157 scarlet fever cases were reported in Guangdong from 2005 to 2017, with the annual incidence rates of 1.46/100 000. More cases were reported in summer and winter. High incidences were reported in Pearl River Delta region, with the proportion of 95.79% to the total cases of the province. Most cases were children aged 3 to 7 years. The proportion of children in kindergarten is the highest, followed by scattered children and students. The incidence of scarlet fever in Guangdong was on the rise, and the AAPC was 26.4%(95%CI: 16.9%–36.7%). The most prevalent emm type of pathogenic bacteria was emm12(65.12%), followed by emm1(32.56%). The strains were all resistant to erythromycin,clindamycin and tetracycline, and the bacteria were all sensitive to pencillin, cefotaxime and levofloxacin. Conclusion The incidence of scarlet fever in Guangdong was on the rise, but no obvious change were observed in the epidemiological patterns.The prevalent emm type of GAS was emm12 and emm1, and strains of GAS were sensitive to pencillin.
引文
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[6]柯碧霞,李柏生,谭海玲,等.广东省猩红热患儿酿脓链球菌病原学特征分析[J].中华微生物学和免疫学杂志,2013,33(5):360-363.DOI:10.3760/cma.j.issn.0254-5101.2013.05.011.Ke BX,Li BS,Tan HL,et al.Etiological characteristics of Streptococcus pyogenes isolated from children with Scarlet fever in Guangdong province,China[J].Chin J Microbiol Immunol,2013,33(5):360-363.DOI:10.3760/cma.j.issn.0254-5101.2013.05.011.
[7]吴双胜,马春娜,彭晓旻,等.北京市2006-2015年猩红热发病特征分析[J].中华流行病学杂志,2017,38(4):514-517.DOI:10.3760/cma.j.issn.0254-6450.2017.04.020.Wu SS,Ma CN,Peng XM,et al.Characteristics on the onset features of scarlet fever in Beijing,2006-2015[J].Chin JEpidemiol,2017,38(4):514-517.DOI:10.3760/cma.j.issn.0254-6450.2017.04.020.
[8]孔德川,陈健,王晔,等.2005-2015年上海市猩红热流行病学特征分析[J].疾病监测,2017,32(5):394-398.DOI:10.3784/j.issn.1003-9961.2017.05.010.Kong DC,Chen J,Wang Y,et al.Epidemiologic characteristics of scarlet fever in Shanghai,2005-2015[J].Dis Surveill,2017,32(5):394-398.DOI:10.3784/j.issn.1003-9961.2017.05.010.
[9]梁江明,黄君,曾竣,等.广西2007-2011年猩红热流行病学分析[J].中国热带医学,2012,12(11):1348-1350.DOI:10.13604/j.cnki.46-1064/r.2012.11.026.Liang JM,Huang J,Zeng J,et al.Epidemiological characteristics of scarlet fever in Guangxi during 2007 to 2011[J].Chin Trop Med,2012,12(11):1348-1350.DOI:10.13604/j.cnki.46-1064/r.2012.11.026.
[10]潘欢弘,刘晓青,杨梦,等.2004-2014年江西省猩红热流行特征分析[J].现代预防医学,2016,43(4):577-579.DOI:10.3969/j.issn.1003-8507.2008.06.009.Pan HH,Liu XQ,Yang M,et al.Epidemiological characteristics of scarlet fever in Jiangxi province from 2004 to 2014[J].Mod Prev Med,2016,43(4):577-579.DOI:10.3969/j.issn.1003-8507.2008.06.009.
[11]曾锦婷,刘爱胜,房笃智,等.深圳宝安区儿童感染致病性A群链球菌流行现状及emm基因分型研究[J].中国优生与遗传杂志,2016,24(7):123-125.DOI:10.13404/j.cnki.cjbhh.2016.07.055.Zeng JT,Liu AS,Fang DZ,et al.Research the epidemic situation and emm genotyping of children infected with pathogenic group AStreptococcus in Shenzhen Baoan district[J].Chin J Birth Health Hered,2016,24(7):123-125.DOI:10.13404/j.cnki.cjbhh.2016.07.055.
[12]肖海军,殷晓晴,张慧莲,等.深圳地区儿童A群致病性链球菌感染流行现状及M蛋白基因分型分析[J].现代检验医学杂志,2016,31(6):51-54.DOI:10.3969/j.issn.1671-7414.2016.06.014.Xiao HJ,Yin XQ,Zhang HL,et al.Analysis of the prevalence status and m protein gene classification of A Group pathogenic Streptococcus infection of children in Shenzhen Area[J].J Mod Lab Med,2016,31(6):51-54.DOI:10.3969/j.issn.1671-7414.2016.06.014.
[13]彭晓旻,杨鹏,吴双胜,等.北京地区2011-2014年致儿童猩红热A组链球菌emm基因型别变化特征分析[J].中华流行病学杂志,2015,36(12):1397-1400.DOI:10.3760/cma.j.issn.0254-6450.2015.12.018.Peng XM,Yang P,Wu SS,et al.emm types of mutation in scarletfever-related group A streptococcal,among children in Beijing,2011-2014[J].Chin J Epidemiol,2015,36(12):1397-1400.DOI:10.3760/cma.j.issn.0254-6450.2015.12.018.
[14]阴杰莹,张维,杨东靖,等.2012-2016年天津市猩红热患儿A组链球菌病原学特征分析[J].中华预防医学杂志,2018,52(10):1045-1049.DOI:10.3760/cma.j.issn.0253-9624.2018.10.015.Yin JY,Zhang W,Yang DJ,et al.Etiological characteristics of Streptococcus pyogenes isolated from children with scarlet fever in Tianjin from 2012 to 2016[J].Chin J Prev Med,2018,52(10):1045-1049.DOI:10.3760/cma.j.issn.0253-9624.2018.10.015.
[15]张代涛,杨鹏,张奕,等.2016-2017年北京市A组链球菌耐药特征及相关因素分析[J].疾病监测,2018,33(11):955-958.DOI:10.3784/j.issn.1003-9961.2018.11.017.Zhang DT,Yang P,Zhang Y,et al.Drug resistance of group AStreptococcus and related factors in Beijing,2016-2017[J].Dis Surveill,2018,33(11):955-958.DOI:10.3784/j.issn.1003-9961.2018.11.017.
[16]刘贞艳,房明,胡彬,等.山东省2013年致猩红热及无症状携带者A群链球菌分子分型研究[J].中华流行病学杂志,2014,35(12):1375-1378.DOI:10.3760/cma.j.issn.0254-6450.2014.12.013.Liu ZY,Fang M,Hu B,et al.Molecular types of group AStreptococcus isolated from scarlet fever patients and asymptomatic carriers in Shandong province,2013[J].Chin JEpidemiol,2014,35(12):1375-1378.DOI:10.3760/cma.j.issn.0254-6450.2014.12.013.
[2]Lamagni T,Guy R,Chand M,et al.Resurgence of scarlet fever in England,2014-16:a population-based surveillance study[J].Lancet Infect Dis,2018,18(2):180-187.DOI:10.1016/S1473-3099(17)30693-X.
[3]Liu YH,Chan TC,Yap LW,et al.Resurgence of scarlet fever in China:a 13-year population-based surveillance study[J].Lancet Infect Dis,2018,18(8):903-912.DOI:10.1016/S1473-3099(18)30231-7.
[4]Luk EYY,Lo JYC,Li AZL,et al.Scarlet fever epidemic,Hong Kong,2011[J].Emerg Infect Dis,2012,18(10):1658-1661.DOI:10.3201/eid1810.111900.
[5]杨芬,钟豪杰,洪腾,等.广东省1950-2011年猩红热发病趋势变化及流行特征分析[J].华南预防医学,2013,39(1):1-5.DOI:10.3969/j.issn.1671-5039.2008.06.001.Yang F,Zhong HJ,Hong T,et al.Incidence trendency and epidemiological characteristics of scarlet fever in Guangdong province,1950-2011[J].South Chin J Prev Med,2013,39(1):1 -5.DOI:10.3969/j.issn.1671-5039.2008.06.001.
[6]柯碧霞,李柏生,谭海玲,等.广东省猩红热患儿酿脓链球菌病原学特征分析[J].中华微生物学和免疫学杂志,2013,33(5):360-363.DOI:10.3760/cma.j.issn.0254-5101.2013.05.011.Ke BX,Li BS,Tan HL,et al.Etiological characteristics of Streptococcus pyogenes isolated from children with Scarlet fever in Guangdong province,China[J].Chin J Microbiol Immunol,2013,33(5):360-363.DOI:10.3760/cma.j.issn.0254-5101.2013.05.011.
[7]吴双胜,马春娜,彭晓旻,等.北京市2006-2015年猩红热发病特征分析[J].中华流行病学杂志,2017,38(4):514-517.DOI:10.3760/cma.j.issn.0254-6450.2017.04.020.Wu SS,Ma CN,Peng XM,et al.Characteristics on the onset features of scarlet fever in Beijing,2006-2015[J].Chin JEpidemiol,2017,38(4):514-517.DOI:10.3760/cma.j.issn.0254-6450.2017.04.020.
[8]孔德川,陈健,王晔,等.2005-2015年上海市猩红热流行病学特征分析[J].疾病监测,2017,32(5):394-398.DOI:10.3784/j.issn.1003-9961.2017.05.010.Kong DC,Chen J,Wang Y,et al.Epidemiologic characteristics of scarlet fever in Shanghai,2005-2015[J].Dis Surveill,2017,32(5):394-398.DOI:10.3784/j.issn.1003-9961.2017.05.010.
[9]梁江明,黄君,曾竣,等.广西2007-2011年猩红热流行病学分析[J].中国热带医学,2012,12(11):1348-1350.DOI:10.13604/j.cnki.46-1064/r.2012.11.026.Liang JM,Huang J,Zeng J,et al.Epidemiological characteristics of scarlet fever in Guangxi during 2007 to 2011[J].Chin Trop Med,2012,12(11):1348-1350.DOI:10.13604/j.cnki.46-1064/r.2012.11.026.
[10]潘欢弘,刘晓青,杨梦,等.2004-2014年江西省猩红热流行特征分析[J].现代预防医学,2016,43(4):577-579.DOI:10.3969/j.issn.1003-8507.2008.06.009.Pan HH,Liu XQ,Yang M,et al.Epidemiological characteristics of scarlet fever in Jiangxi province from 2004 to 2014[J].Mod Prev Med,2016,43(4):577-579.DOI:10.3969/j.issn.1003-8507.2008.06.009.
[11]曾锦婷,刘爱胜,房笃智,等.深圳宝安区儿童感染致病性A群链球菌流行现状及emm基因分型研究[J].中国优生与遗传杂志,2016,24(7):123-125.DOI:10.13404/j.cnki.cjbhh.2016.07.055.Zeng JT,Liu AS,Fang DZ,et al.Research the epidemic situation and emm genotyping of children infected with pathogenic group AStreptococcus in Shenzhen Baoan district[J].Chin J Birth Health Hered,2016,24(7):123-125.DOI:10.13404/j.cnki.cjbhh.2016.07.055.
[12]肖海军,殷晓晴,张慧莲,等.深圳地区儿童A群致病性链球菌感染流行现状及M蛋白基因分型分析[J].现代检验医学杂志,2016,31(6):51-54.DOI:10.3969/j.issn.1671-7414.2016.06.014.Xiao HJ,Yin XQ,Zhang HL,et al.Analysis of the prevalence status and m protein gene classification of A Group pathogenic Streptococcus infection of children in Shenzhen Area[J].J Mod Lab Med,2016,31(6):51-54.DOI:10.3969/j.issn.1671-7414.2016.06.014.
[13]彭晓旻,杨鹏,吴双胜,等.北京地区2011-2014年致儿童猩红热A组链球菌emm基因型别变化特征分析[J].中华流行病学杂志,2015,36(12):1397-1400.DOI:10.3760/cma.j.issn.0254-6450.2015.12.018.Peng XM,Yang P,Wu SS,et al.emm types of mutation in scarletfever-related group A streptococcal,among children in Beijing,2011-2014[J].Chin J Epidemiol,2015,36(12):1397-1400.DOI:10.3760/cma.j.issn.0254-6450.2015.12.018.
[14]阴杰莹,张维,杨东靖,等.2012-2016年天津市猩红热患儿A组链球菌病原学特征分析[J].中华预防医学杂志,2018,52(10):1045-1049.DOI:10.3760/cma.j.issn.0253-9624.2018.10.015.Yin JY,Zhang W,Yang DJ,et al.Etiological characteristics of Streptococcus pyogenes isolated from children with scarlet fever in Tianjin from 2012 to 2016[J].Chin J Prev Med,2018,52(10):1045-1049.DOI:10.3760/cma.j.issn.0253-9624.2018.10.015.
[15]张代涛,杨鹏,张奕,等.2016-2017年北京市A组链球菌耐药特征及相关因素分析[J].疾病监测,2018,33(11):955-958.DOI:10.3784/j.issn.1003-9961.2018.11.017.Zhang DT,Yang P,Zhang Y,et al.Drug resistance of group AStreptococcus and related factors in Beijing,2016-2017[J].Dis Surveill,2018,33(11):955-958.DOI:10.3784/j.issn.1003-9961.2018.11.017.
[16]刘贞艳,房明,胡彬,等.山东省2013年致猩红热及无症状携带者A群链球菌分子分型研究[J].中华流行病学杂志,2014,35(12):1375-1378.DOI:10.3760/cma.j.issn.0254-6450.2014.12.013.Liu ZY,Fang M,Hu B,et al.Molecular types of group AStreptococcus isolated from scarlet fever patients and asymptomatic carriers in Shandong province,2013[J].Chin JEpidemiol,2014,35(12):1375-1378.DOI:10.3760/cma.j.issn.0254-6450.2014.12.013.